vanco po given im?
- 0Sep 27, '06 by RN2B07Hi I have been working with a LPN doing team nursing...I am worried because she told the charge RN that one of our pts gets vanco IM. She gives all injections and p.o. meds. Now the following day we had the same pt. group and a SN asked to give the vanco. The LPN said oh...you get to give an IM injection. The SN looked at the MAR and said, no its po. The LPN just stared blankly for a second and said oh right. But I think she had been giving it IM. What would happen? I am scared. Only worked with this LPN 4-5 times and I dont trust her. Please help!
- 0Unless the order changed???
And are you really sure this LPN has been giving it incorrectly?
Check your facts first. Also, make sure there hasn't been a transcription error.
Otherwise, it's a med error and should be treated as such--that is, you need to write an incident report, call the Pharmacy, and call the doc to find out what significance this could have to the patient.
*I would certainly ask for a Vanco trough when calling the doc.*Last edit by Angie O'Plasty, RN on Sep 27, '06
- 0Sep 27, '06 by MarkthemalenurseWho is signing the MARS saying they are giving the med? Is the IM Vanco the same dosage as the PO Vanco? If the IM is stronger then the patient could be getting an overdose. Try to find the original doctors order to see if it is IM or PO. If it is PO and the nurse has been giving it IM then this is a med error and should be reported.
- 0Quote from JolieYes, ours do. It's pretty hard to confuse a po dose (orange) with an IV dose (clear), but I've seen stranger things happen.I think the formulation is the same whether it is given IV, IM or po.
But I would certainly be concerned about the possibility of cellulitis from injecting a non-sterile drug. Don't your oral meds come in syringe that won't accept a needle?
- 0Sep 27, '06 by caroladybelleThe problem that I see is that first that a PO preparation should not go IM, due to cellulitis issues as well as infection issues from an unsterile med going into tissue.
But an even bigger issue, PO Vanco and IV vanco are used for totally different purposes. PO Vanco is not absorbed systemically. As such, it is used to "sterilize" the bowel, when the GI tract is infected (think C.Diff). The IV preparation is used for systemic infection. That is why IV Vanco can not be switched over to PO for OP use. The dosing is also different, with PO vanco being dosed usually Q6h in lower doses (250mg) vs IV vanco QD or Q12h and 1000-1500mg .
So if the patient is suffering from a GI infection, and receiving PO vanco for it, getting it IM is not effective.
I personally havenever seen the drug given IM.
- 0Sep 27, '06 by RN2B07Let me clarify...original order was for po. Last post was correct because pt had recurring C-Diff infections. Thats why she was on po. The po vial is a powder mixed with sterile water...when mixed is clear. The MAR states for oral use only! I dont know for sure but she was the one giving it 250mg qid...and said in report pt was receiving IM vanco. I never heard of it...but she had been giving it.
- 0Quote from RN2B07Let me clarify...original order was for po. Last post was correct because pt had recurring C-Diff infections. Thats why she was on po. The po vial is a powder mixed with sterile water...when mixed is clear. The MAR states for oral use only! I dont know for sure but she was the one giving it 250mg qid...and said in report pt was receiving IM vanco. I never heard of it...but she had been giving it.
Oops, my bad, you're right the PO dose is clear, but our Pharmacy sends it up in an orange dropper-type syringe, premixed.
Anyhow, it's obviously a med error at this point. I think you also need to visually check the sites where the IMs were given and assess them before calling the doc, in addition to the other stuff.